P77PMC大鼠听源性惊厥神经回路──核团损毁研究

采用立体定位直流电损毁法,分别损毁双侧下丘、脑桥吻侧网状核、内侧膝状体、黑质,观察核团损毁对大鼠听源性惊厥行为的影响,以寻找与P77PMC大鼠听源性惊厥有关的神经核团。结果表明：双侧下丘损毁后能完全阻断强直阵挛性惊厥,脑桥吻侧网状核损毁能明显减少惊厥发生（P＜0．05）,而双侧内侧膝状体及黑质损毁对惊厥无明显影响（P＜0．05）。提示下丘是P77PMC大鼠听源性惊厥的关键核团,而脑桥吻侧网状核可能参与了惊厥回路,内侧膝状体可能并未参与惊厥回路,黑质在此惊厥中的作用尚不明确。     

听源性惊厥易感大鼠中脑导水管周围灰质内突触素的表达

目的 分析正常及点燃后听源性惊厥易感大鼠中脑导水管周围灰质（ＰＡＧ）内突触密度的变化情况。方法 用免疫细胞化学方法和计算机图像分析技术。结果 正常和点燃后听源性惊厥易感大鼠ＰＡＧ内突触素Ｐ３８凤应产物的校正光密度值（ＣＯＤ）均显著高于正常Ｗｉｓｔａｒ大鼠;点燃后听源性惊厥易感大鼠ＰＡＧ背侧及背外侧两个亚区内突触素Ｐ３８免疫反应产物的ＣＯＤ去值显著高于正常听源性惊厥易感大鼠。     

儿童期常见非癫癎性发作的临床及脑电图特点

目的:总结儿童期常见非癫癎性发作(Non-Epilepsy Seizure,NES)的临床及脑电图特点,以提高临床医生的诊断水平,减少误诊;并探讨视频脑电图( Video-EEG,VEEG)在诊断儿童NES中的应用价值.方法:回顾性分析2008年1月至2010年12月在我院行VEEG后诊断为NES的328例患儿的临床及脑电图资料.结果:良性新生儿肌阵挛或颤抖18例、良性非癫癎性婴儿痉挛14例、非癫癎性强直发作39例、情感性交叉擦腿19例、屏气发作9例、睡眠障碍108例、抽动障碍43例、偏头痛18例、晕厥23例、癔症性发作4例、其他33例.126例患儿监测到临床发作,且同期脑电图均未记录到癎性发放.17例癫癎患儿合并NES,21例NES合并发作间期癫癎样波发放.结论:儿童期常见各种类型NES,通过详细询问病史获得可靠的发作期症状,并辅以脑电图检查可做出正确诊断.视频脑电图是明确儿童NES的类型,鉴别NES和ES的最可靠的检查方法.     

Characteristics of temporal lobe epilepsy with no ictal impairment of consciousness

Introduction

The predominant manifestations of temporal lobe epilepsy (TLE) are partial seizures with impairment of consciousness (type I.B of ILAE classification), although consciousness impairment is not necessary in all seizures of patients with TLE. Nevertheless, there have been very few reports of TLE patients with exclusive seizures with no impairment of consciousness (i.e. isolated auras). The objective of this study was to determine any differential characteristics of this subgroup of TLE patients.

Material and methods

Retrospective case-control study in 163 consecutive TLE patients from our hospital database. The patients were divided between those with and without ictal impairment of consciousness, based on directed semi-structured questionnaire to the patient and relatives and on video–EEG records. Ten independent variables (8 clinical and 2 paraclinical) were compared between the groups.

Results

14 patients (8.5%) formed the “TLE without ictal impairment of consciousness” group. This group was less refractory to medical treatment [Odds Ratio: 0.14 (0.03–0.64); p < 0.01] and had frequent ictal motor behaviour [Odds ratio: 5.33 (1.65–17.14); p = 0.008] and less frequent presence of automatisms [p < 0.001]. Non-significant tendencies were observed for a higher frequency of lesional substrate and fewer generalization episodes.

Discussion

TLE without ictal impairment of consciousness appears to be more frequent than previously thought. This subgroup of TLE patients shows differential characteristics that may possibly result from a differential propagation of the original epileptic activity towards frontal areas rather than towards neocortical and diencephalic structures, which may be related to the more frequent presence of structural lesions.     

Role of Quantitative Electroencephalography,Neurotherapy, and Neuroplasticity in Recovery from Neurological and Psychiatric Disorders

Introduction. Until recently, patients with brain injuries had poor prognosis for recovery, but new insights into neuroplasticity and neurorehabilitation have significantly improved outcomes. Neurotherapy or neurofeedback is one of those promising techniques for neurorehabilitation.

Methods. Neurofeedback or EEG biofeedback, as it is also called, uses operant conditioning to reinforce desirable self-regulated changes in EEG rhythms, changes that are believed to correspond to reorganization in neural networks, particularly in thalamocortical and corticothalamic circuits. Sensorimotor rhythm reinforcement has been effective in facilitating recovery in patients with traumatic brain injury, stroke, seizures, and certain sleep disorders.

Results. We describe the case of a 19-year-old man with severe, partial secondarily generalized seizures that did not respond to extensive conventional treatments including all antiepilepsy drugs.

Conclusion. He underwent two 3-week sessions of daily neurotherapy, which produced remarkable EEG and behavioral normalization.     

Positive and negative network correlations in temporal lobe epilepsy

Temporal lobe seizures are accompanied by complex behavioral phenomena including loss of consciousness, dystonic movements and neuroendocrine changes. These phenomena may arise from extended neural networks beyond the temporal lobe. To investigate this, we imaged cerebral blood flow (CBF) changes during human temporal lobe seizures with single photon emission computed tomography (SPECT) while performing continuous video/EEG monitoring. We found that temporal lobe seizures associated with loss of consciousness produced CBF increases in the temporal lobe, followed by increases in bilateral midline subcortical structures. These changes were accompanied by marked bilateral CBF decreases in the frontal and parietal association cortex. In contrast, temporal lobe seizures in which consciousness was spared were not accompanied by these widespread CBF changes. The CBF decreases in frontal and parietal association cortex were strongly correlated with increases in midline structures such as the mediodorsal thalamus. These results suggest that impaired consciousness in temporal lobe seizures may result from focal abnormal activity in temporal and subcortical networks linked to widespread impaired function of the association cortex.